The Enhancing Connections Program: a six-state randomized clinical trial of a cancer parenting program.

OBJECTIVE The purpose of this study was to test the efficacy of a cancer parenting program for child rearing mothers with breast cancer, the Enhancing Connections Program. Primary goals were to decrease maternal depressed mood and anxiety, improve parenting quality, parenting skills and confidence, and enhance the child's behavioral-emotional adjustment to maternal breast cancer. METHOD A total of 176 mothers diagnosed within 6 months with Stage 0 to Stage III breast cancer and their 8- to 12-year-old child were recruited from medical providers in 6 states: Washington, California, Pennsylvania, Minnesota, Arizona, and Indiana. After consenting and obtaining baseline measures, study participants were randomized into experimental or control groups. Experimental mothers received 5, 1-hr educational counseling sessions at 2-week intervals; controls received a booklet and phone call on communicating and supporting their child about the mother's cancer. Outcomes were assessed at 2 and 12 months. RESULTS Compared to controls, at 2 months experimental mothers significantly improved on depressed mood and parenting skills; experimental children improved on behavioral-emotional adjustment: total behavior problems, externalizing problems, and anxiety/depressed mood significantly declined. At 1 year, experimental children remained significantly less depressed than controls on both mother- and child-reported measures. The intervention failed to significantly affect parenting self-efficacy or maternal anxiety. CONCLUSIONS The Enhancing Connections Program benefitted mothers and children in specific areas and warrants refinement and further testing.

[1]  C. Edelbrock,et al.  The classification of child psychopathology: a review and analysis of empirical efforts. , 1978, Psychological bulletin.

[2]  F. Lewis,et al.  Mothers' Stories of the School-Age Child's Experience with the Mother's Breast Cancer , 1999 .

[3]  R. Lerner,et al.  Developmental contextual perspective on parenting. , 1995 .

[4]  J. Twisk,et al.  Longitudinal Data Analysis. A Comparison Between Generalized Estimating Equations and Random Coefficient Analysis , 2003, European Journal of Epidemiology.

[5]  Qualitative interview study of communication between parents and children about maternal breast cancer. , 2000, BMJ.

[6]  D. While,et al.  Children's Adjustment During the First Year of a Parent's Cancer Diagnosis , 2002 .

[7]  Brady T. West,et al.  Linear Mixed Models: A Practical Guide Using Statistical Software , 2006 .

[8]  A. Bandura.  Self-efficacy mechanism in human agency. , 1982 .

[9]  C. Gerhardt,et al.  Associations of Child Adjustment With Parent and Family Functioning: Comparison of Families of Women With and Without Breast Cancer , 2010, Journal of developmental and behavioral pediatrics : JDBP.

[10]  M. Thastum,et al.  Evaluation of a Focused Short-term Preventive Counselling Project for Families with a Parent with Cancer , 2006, Clinical child psychology and psychiatry.

[11]  H. Hoekstra,et al.  Emotional and behavioural functioning of children of a parent diagnosed with cancer: a cross‐informant perspective , 2005, Psycho-oncology.

[12]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[13]  B. Laursen,et al.  Changing Relationships, Changing Youth , 2004 .

[14]  A. Stein,et al.  Factors predicting communication about the diagnosis of maternal breast cancer to children. , 2002, Journal of psychosomatic research.

[15]  G. Armsden,et al.  The child's adaptation to parental medical illness: theory and clinical implications. , 1993, Patient education and counseling.

[16]  N. Ryan-Wenger,et al.  Children's Adjustment to Parental Cancer: A Theoretical Model Development , 2007, Cancer nursing.

[17]  B. Fuemmeler,et al.  Adjustment of children and their mothers with breast cancer. , 2006, Journal of pediatric psychology.

[18]  B. Compas,et al.  Adjustment of children and adolescents to parental cancer: Parents' and children's perspectives , 1996, Cancer.

[19]  F. Lewis,et al.  Mother and child interactions about the mother's breast cancer: an interview study. , 2000, Oncology nursing forum.

[20]  A. Muriel,et al.  The importance of parenting concerns among patients with cancer. , 2004, Critical reviews in oncology/hematology.

[21]  F. Lewis.  Therapy for Parental Cancer and Dependent Children , 2011 .

[22]  Mary Pepping,et al.  Major depression after breast cancer: a review of epidemiology and treatment. , 2008, General hospital psychiatry.

[23]  D. C. Howell,et al.  Risk factors for emotional/behavioral problems in young adolescents: a prospective analysis of adolescent and parental stress and symptoms. , 1989, Journal of consulting and clinical psychology.

[24]  L. Issel,et al.  How children cope with mother's breast cancer. , 1990, Oncology nursing forum.

[25]  F. Lewis.  Parental cancer and dependent children: selected issues for future research , 2007, Psycho-oncology.

[26]  F. Lewis,et al.  The enhancing connections program: pilot study of a cognitive‐behavioral intervention for mothers and children affected by breast cancer , 2006, Psycho-oncology.

[27]  A. Bandura.  Health Promotion by Social Cognitive Means , 2004, Health education & behavior : the official publication of the Society for Public Health Education.

[28]  M. Jordan-Marsh,et al.  A Multidimensional, Dual-Perspective Index of Parental Support , 1985, Western journal of nursing research.

[29]  B. E. Compas,et al.  Coping with stressful events in older children and young adolescents. , 1988, Journal of consulting and clinical psychology.

[30]  F. Lewis,et al.  The Father's, Mother's, and Adolescent's Functioning with Breast Cancer , 1996 .

[31]  Parental Support and School-Aged Children , 1983, Western journal of nursing research.

[32]  W. T. van der Graaf,et al.  Psychosocial Consequences for Children of a Parent With Cancer: A Pilot Study , 2003, Cancer nursing.

[33]  C. Spielberger,et al.  Manual for the State-Trait Anxiety Inventory , 1970 .

[34]  B. Given,et al.  Does a symptom management intervention affect depression among cancer patients: Results from a clinical trial , 2004, Psycho-oncology.

[35]  K. Glanz,et al.  Stress, coping, and health behavior. , 2008 .

[36]  J. Zabora,et al.  Measuring Depression in African American Cancer Survivors: The Reliability and Validity of the Center for Epidemiologic Study—Depression (CES-D) Scale , 2002, Journal of health psychology.

[37]  D. A. Smith,et al.  Couples coping with a myocardial infarction: a contextual perspective on wives' distress. , 1991, Journal of personality and social psychology.

[38]  M. Weissman,et al.  Remissions in Maternal Depression and Child Psychopathology: A STAR*D-Child Report , 2006, JAMA.

[39]  A. Bandura.  Social cognitive theory: an agentic perspective. , 1999, Annual review of psychology.

[40]  L. Radloff.  The CES-D Scale , 1977 .

[41]  J. Rowland,et al.  Parental cancer and the family , 2010, Cancer.

[42]  S. Ashley,et al.  Factors associated with emotional and behavioural problems among school age children of breast cancer patients , 2005, British Journal of Cancer.

[43]  Cecil R. Reynolds,et al.  Revised Children's Manifest Anxiety Scale (RCMAS). Manual , 1985 .

[44]  Robert L. Leahy,et al.  The Use of Psychological Testing for Treatment Planning and Outcome Assessment , 2000, Journal of Cognitive Psychotherapy.

[45]  C. Bender,et al.  The impact of parental cancer on the adolescent: an analysis of the literature , 2007, Psycho-oncology.

[46]  H. Kales,et al.  Four-Year Predictive Value of the Children's Depression Inventory , 1990 .

[47]  D. C. Howell,et al.  When mom or dad has cancer: II. Coping, cognitive appraisals, and psychological distress in children of cancer patients. , 1996, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[48]  D. C. Howell,et al.  When mom or dad has cancer: markers of psychological distress in cancer patients, spouses, and children. , 1994, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[49]  J. Coyne,et al.  Living with a depressed spouse. , 2000, Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association.

[50]  Armsden Gc,et al.  Behavioral adjustment and self-esteem of school-age children of women with breast cancer. , 1994 .

[51]  K. Hodges.  Depression and anxiety in children: A comparison of self-report questionnaires to clinical interview. , 1990 .

[52]  R. Kessler,et al.  Living with a depressed person. , 1987, Journal of consulting and clinical psychology.

[53]  W. Collins,et al.  Parenting During Middle Childhood , 2002, Handbook of Parenting.

[54]  J. C. Perry,et al.  Maternal preoccupation and parenting as predictors of emotional and behavioral problems in children of women with breast cancer. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[55]  E. Zahlis.  The child's worries about the mother's breast cancer: sources of distress in school-age children. , 2001, Oncology nursing forum.